CAPD Testing and Retention

Q: My first-grader had tubes put in her ears and her adenoids removed in November. That helped with her hearing, but she is still struggling with schoolwork, her spelling is not improving, and she confuses many letter sounds. Our doctor suggested getting her screened for CAPD. My question is what is the best way to go about this, since this is the last week of school? We will be changing schools next year and I am afraid that they may want to have her repeat first grade, which will damage her already struggling self-esteem. She is truly working hard to read better and we are seeing gradual improvement, although not equal to the effort she is investing.

A: The fact that your daughter's hearing improved with tubes (myringotomy) suggests that her hearing wasn't so efficient before the tubes got put in. Kids who have hearing losses when they are younger may not hear sounds accurately. This means that when the auditory sensation goes to the listening centers of the brain, the message is stored in its incorrect form. In other words if the short vowel sounds of /e/ and /i/ sound the same, the brain doesn't have the ability to discriminate between these two sounds when they arrive in the brain -- so "get" and "git" are heard as the same sound. The same thing is true for longer auditory stimuli, like requests from a teacher.

If hearing is poor at an early age, the brain is ill equipped to make sense of messages it hears. For this reason, some kids may have what's called a central auditory processing deficit (CAPD). I would follow the advice of your doctor. A CAPD evaluation is usually done by a team made up of an audiologist and a speech and language pathologist, who use specialized assessments to make this diagnosis.

If your daughter has CAPD, then she needs specialized therapy that can help her process what her ears hear in a more efficient way. Simply repeating a grade won't do that. She needs a combination of therapy and a teacher who believes and understands the CAPD diagnosis and what she can do in the classroom to help your daughter process auditory information more efficiently. However, if the CAPD is diagnosed and a treatment program is begun, your daughter may benefit from having the chance to get exposed again to a first grade curriculum that she can now master. This will go a long way toward rebuilding an eroded self-concept. Moving into second grade with a poor foundation may lead to even greater frustrations and a crumbling sense of self. Get the evaluation and then decide. Use the expertise of the CAPD diagnostic team to help you make this important decision -- and get the CAPD evaluation done as soon as you can, so you can start treatment over the summer.

Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.

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